Saturday, March 14, 2009

Part of the 47 Million No One Wants You to See

"Mariana de la Torre, 28, speaking of living illegally in the United States and a medical odyssey that saw her steal another woman's identification, undergo treatment for cervical cancer at three Illinois hospitals and rack up $530,000 in medical bills covered by Medicaid and other charity programs.

Mariana de la Torre, 28, cries at Trinity Medical Center in Rock Island as she talks about her children in Mexico. De la Torre, who came to the U.S. illegally in 2006, was diagnosed with cancer in 2007 but put off treatment for several months because of her lack of a proper ID. She was first admitted to the medical center in May 2007 by using someone's ID and medical card, but her cancer became terminal. Her only wish later was to return to Mexico to see her family."

One patient. Over half a million dollars. Of another American's health insurance.

Granted, it's an extreme example. But some have estimated that 10 million of the 47 million uninsured in America are here illegally.

Importantly, this story is not just about this patient, but rather about the pressing global health concerns that are right on our border, not to mention all over the world. With this perspective in mind, it is clear that our current proposals for health care reform are unambitious. How do we address the endless needs presented by undocumented immigrants without dealing straight-on with the immigration problem? Is there an American consensus about how we should divvy up our health care dollar when it comes to these health care crises?

There is a way that every hospital (and every employer for that matter) could have a 98% accuracy in documenting whether a patient/employee is legal: the Department of Homeland Security's E-Verify program, but so far we have lacked the political and moral resolve to implement such a system.

So what is our plan?

This story points out to all of us that continuing to look the other way is a failed strategy. We need an honest discussion of our limitations, not just manipulation of America's compassion.

-Wes

Addendum: De la Torre's follow-up story that appeared today in the Chicago Tribune and inspired this post.

7 comments:

Keith Sarpolis
said...

Wes,

I agree! I see these villanous creatures sneeking onto the North Shore all the time in thir well disgusied landscaping trucks. Some have even been discovered cleaning our houses! They are taking over America and we must close the borders to this human detritus before it's too late.

By the way, is that half mil in the usual 300-500 per cent hospital mark up, or is it in actual cost of the service?

We share this planet together, and until we help other nations to develop their enomomies and offer their citizens the same path out of poverty, they will continue to try to come here, legally or illegally. Aftr all, what would you do if you were unfortunate enough to have been born in Chiapas, Mexico or Guatamala? And if you developed a serious cancr?

As a matter of fact, I was having dinner with one of those “Cannucks” who worked as a public health consultant the other night. She mentioned that Canada’s hospitals are owned by the government and are not private, and even with their lower costs and doctors donating their time, the immigrant issue weighs heavily on the fiscal solvency of their health care system. From this Canadian Medical Association Journal article, we can see the problem:

“Our uninsured patients who require hospital care pose special challenges. Although our hospital has reduced fees and allows delayed payment from patients without health insurance, and our consultants donate their time, demand and costs nevertheless exceed our ability to respond, and some patients still do not receive medically necessary care. In some instances, uninsured immigrants have returned to their home country to access hospital care. Others who are entitled to health benefits lack the knowledge, documentation or means to secure them: 5% of our uninsured youth, mostly children born in Canada to uninsured newcomers, are in fact Canadian citizens. Considerable numbers of immigrants and refugees reside legally in Canada without any entitlement to public health insurance. People in this population are much less likely to seek medical care.”

There seems to be some magical thinking that if we just cut our payments to providers, costs of hospitalization and treatments and ignore this issue, that fiscal solvency will be assured.

Certainly, I am no more a fan of inflated hospital costs than you care, but the real task before us is health care sustainability in this country, not cheap virtue.

I would totally agree. Thats why we need to stop directing our resources in health care to items like breast augmentation and tummy tucks and stop removing dozens of prostates with no proven benefit of therapy. We also nneed to stop building medical Taj Mahals as you have noted in your previous posts.

Having read the story today in the Trib., whats most sad abut that particular case is the woman had a very preventable disease, but because of the barriers to accessing care and the cost, delayed treatment till it became a half million dollar problem. Can't our non profit institutions even offer to subsidize a pap smear or mammography for low income patients? If this patinet had immigrated to Canada instead, she might not have even suffered this tragedy. What does this say for the "greatest health care system on the planet". This is why our statistics of basic measures of health care are so far down the list compared to our peers in the industrialized world. We spend 600 billion a year on "defense" while we let this type of thing happen. Then we spend more money erecting a wall to keep the rest of the world out. But we still want to exploit the natural resources of many of these countries to or own benefit. Maybe thats the reality of the world, but I don't think docs should accept it as such. Our talented hospital and health care CEO's should be using their amzaing powers and talents to show us how to manage these issues more responsibly instead of showing us how to accumulate cash and power.

I have to wonder what sort of air is circulating on Keith's planet, where there are infinite resources, medical and otherwise, to meet the unlimited needs of every human being who presents themself for free care?? And I notice a distinct lack of compassion for the poor woman who had her identity stolen and may now be a half-million in debt that is not hers, ruining her very life as well?? The pictures are all very sad....and sadly common throught the planet. A pathetic photo shoot is a straw man for the reality of limited medical care and illegal aliens...

I reside on the planet Verion, where there are indeed unlimited resources and people who have actually traveled to other countries where extreme poverty exists and know that it is not the fault of there own.

And that poor woman who had her identity stolen? Keep in mind it was all billed to public aid and that there is no billing that occurrs or any statement of benefits. That is why this fraud could be perpetrated for so long without her knowing. She has no liability in this situation unless the patient in question took out credit cards and other forms of credit. That was rather unlikely until recently when anyone with a pulse could get credit thanks to our wonderful banking system. By the way, maybe you should be directing your wonderment at that crowd that perpetrated the biggest ponzi scheme of all on all of us and walked away gazillionaires while we and our children will be paying for years to come. How about zeroing in on that fraud instead of some poor woman dying of cervical cancer.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.